H i X! Judicial District n .—, GA

SUMMONS - CIVIL JD-CV-1 Rev. 4-16 C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259, P.B. §§ 3-1 through 3-21, 8-1, 10-13

See other side for instructions

STATE OF CONNECTICUT SUPERIOR COURT

www.jud.ct.gov

|—i "X" if amount, legal interest or property in demand, not including interest and '—' costs is less than $2,500. r^i "X" if amount, legal interest or property in demand, not including interest and '—' costs is $2,500 or more.

I I "X" if claiming other relief in addition to or in lieu of money or damages.

TO: Any proper officer; BY AUTHORITY OF THE STATE OF CONNECTICUT, you are hereby commanded to make due and legal service of this Summons and attached Complaint. Address of court clerk where writ and other papers shall be filed (Number, street, town and zip code) (C.G.S. §§ 51-346, 51-350)

95 Washington Street, Hartford, CT 06106 0

Telephone number of clerk (with area code)

( 860 ) 548-2700

Return Date (Must be a Tuesday)

August j if 2 018 Month Dav Year

i X! Judicial District .—, "A H n GA | I Housing Session '—' Number:

At (Town in which writ is returnable) (C.G.S. §§ 51-346, 51-349)

Hartford

Case type code (See list on page 2)

Major: M Minor: 90

For the Plaintiff(s) please enter the appearance of: Name and address of attorney, law firm or plaintiff if self-represented (Number, street, town and zip code)

AAG Richard M. Porter, Office of the Attorney General, 55 Elm St., P.O. Box 120, Hartord, CT 06141

Juris number (to be entered by attorney only)

423015 Telephone number (with area code)

( 860 ) 808-5040

Signature of Plaintiff (If self-represented)

The attorney or law firm appearing for the plaintiff, or the plaintiff if . seif-represented, agrees to accept papers (service) electronically in [xj Yes No this case under Section 10-13 of the Connecticut Practice Book.

Email address for delivery of papers under Section 10-13 (if agreed to) [email protected]

Number of Plaintiffs: 1 Number of Defendants: 1 | | Form JD-CV-2 attached for additional parties

Parties Name (Last, First, Middle Initial) and Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, if not USA)

First Plaintiff

Name: State of Connecticut c/o Office of the Attorney General P-°1 Address: 55 Bm p a Box 120I Hartord, CT 06141-0120

Additional Plaintiff

Name: P-02 Address:

First Defendant

Name: Susan Britt d/b/a An Inner Peace D-°1

Address: Nemczuk Drive, Norwich, CT 06360

Additional Defendant

Name: D-02 Address: „


Name: D"03

Address:


Name: D-04 Address:

Notice to Each Defendant 1. YOU ARE BEING SUED. This paper is a Summons in a lawsuit. The complaint attached to these papers states the claims that each plaintiff is making

against you in this lawsuit. 2. To be notified of further proceedings, you or your attorney must file a form called an "Appearance" with the clerk of the above-named Court at the above

Court address on or before the second day after the above Return Date. The Return Date is not a hearing date. You do not have to come to court on the Return Date unless you receive a separate notice telling you to come to court.

3. If you or your attorney do not file a written "Appearance" form on time, a judgment may be entered against you by default. The "Appearance" form may be obtained at the Court address above or at www.jud.ct.gov under "Court Forms."

4. If you believe that you have insurance that may cover the claim that is being made against you in this lawsuit, you should immediately contact your insurance representative. Other action you may have to take is described in the Connecticut Practice Book which may be found in a superior court law library or on-line at www.jud.ct.gov under "Court Rules."

5. If you have questions about the Summons and Complaint, you should talk to an attorney quickly. The Clerk of Court is not allowed to give advice on legal questions.

Signed (Sign and "X" proper tod / y I Commissioner of the / J ,/y //Py /"? Superior Court

// | | Assistant Clerk

Name of Person Signing at Left .

Richard M. Porter

Date signed

06/ /2018

If this Summons is signed by a Clerk: a. The signing has been done so that the Plaintiff(s) will not be denied access to the courts. b. It is the responsibility of the Plaintiff(s) to see that service is made in the manner provided by law. c. The Clerk is not permitted to give any legal advice in connection with any lawsuit. d. The Clerk signing this Summons at the request of the Piaintiff(s) is not responsible in any way for any errors or omissions

in the Summons, any allegations contained in the Complaint, or the service of the Summons or Complaint.

For Court Use Only File Date

I certify I have read and understand the above:

Signed (Self-Represented Plaintiff) Date Docket Number

| Print Form | I Reset Form

RETURN DATE: AUGUST 14,2018

STATE OF CONNECTICUT Plaintiff

SUPERIOR COURT

v. JUDICIAL DISTRICT OF HARTFORD

SUSAN BRITT Defendant JUNE 19,2018

COMPLAINT

The Plaintiff, the State of Connecticut, represented by George Jepsen, Attorney General

for the State of Connecticut, alleges the following against the Defendant, Susan Britt (Defendant

Britt).

The Plaintiff, the State of Connecticut, brings this complaint under the Connecticut False

Claims Act (Act), Conn. Gen. Stat. §§ 4-274 et seq. The complaint alleges that during the period

beginning at least as early as January 2013 and continuing through at least September 2016,

Defendant Britt engaged in a pervasive and illegal scheme to bill the Connecticut Medicaid

program and collect tens of thousands of dollars for services she never provided to her Medicaid

patients. This complaint alleges that Defendant Britt knowingly created and submitted false

claims for reimbursement for behavioral health services which she never provided to indigent

and/or disabled Connecticut residents who receive health care through Connecticut's Medicaid

program, and that she concealed her obligation to repay the state by either failing to maintain any

patient records or destroying them. The State of Connecticut seeks treble damages, civil

penalties, and other relief available under the Act for Defendant Britt's illegal conduct.

The Attorney General also brings this complaint on behalf of the Connecticut Department

of Social Services (Department or DSS) under the common law of contract. The complaint

SUMMARY

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further alleges that Defendant Britt breached her duty arising under her agreement with the DSS

to maintain records of all services she claimed to have provided to her Medicaid clients, and to

provide these records to the DSS when requested in order to support the claims for

reimbursement that she submitted and received payment for. The complaint alleges that she

breached these duties when she either never maintained any patient records, or, as she has

claimed, destroyed all of them, and failed to provide to DSS's agents any records to support the

$530,000 worth of claims she submitted to and was reimbursed by the Medicaid program.

PARTIES

1. The Plaintiff is the State of Connecticut, represented by George Jepsen, Attorney

General. The Attorney General brings Counts One and Two, alleging violations of the Act,

pursuant to the authority granted to him by the Act. The Act authorizes the Attorney General to

bring a civil action in the name of the state if he finds that a person has violated the Act. Conn.

Gen. Stat. § 4-276. The Attorney General brings Count Three of this complaint as the legal

representative of the DSS, alleging that Defendant Britt breached her agreement with the DSS.

2. Defendant Britt is a professional counselor licensed by the State of Connecticut.

She resides and works in Norwich, Connecticut.

3. During the relevant time period for the events described in this complaint

Defendant Britt transacted business in the State of Connecticut under her name and under the

tradename "An Inner Peace."

4. The relevant time period for the causes of action set forth below is at least as early

as January 2013 through September 2016.

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LEGAL AND PUBLIC POLICY BACKGROUND

5. The Act provides in relevant part, with respect to claims for payment or

obligations to pay money under a state-administered health or human services program, that any

person who:

(a) knowingly presents, or causes to be presented, a false or fraudulent claim for payment

or approval; Conn. Gen. Stat. § 4-275 (a)(1); or

(b) knowingly conceals or knowingly and improperly avoids or decreases an obligation to

pay or transmit money or property to the state; Conn. Gen. Stat. § 4-275 (a)(8);

is liable to the State of Connecticut for relief, including civil penalties and treble damages. Conn.

Gen. Stat. § 4-275 (b).

6. For the purposes of the Act, "state-administered health or human services .

program" includes without limitation all programs administered by the DSS. Conn. Gen. Stat.

§ 4-274(7).

7. For the purposes of the Act: "knowing" and "knowingly" means that a person,

with respect to information: (a) has actual knowledge of the information; (b) acts in deliberate

ignorance of the truth or falsity of the information; or (c) acts in reckless disregard of the truth or

falsity of the information, without regard to whether the person intends to defraud. Conn. Gen.

Stat. § 4-274(1); and "obligation" means, among other things, an established duty, whether fixed

or not, arising from the retention of an overpayment. Conn. Gen. Stat. § 4-274(5).

8. The DSS administers the Connecticut Medical Assistance Program (CMAP). The

CMAP includes the State of Connecticut's Medicaid program. The CMAP, including Medicaid,

is a state-administered health or human services program. Conn. Gen. Stat. § 4-274(7). The

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CMAP pays enrolled healthcare providers for health care benefits provided to program

recipients.

9. Medicaid is a joint federal-state program that provides health care benefits for

certain groups of persons, including the indigent and disabled. The federal Medicaid statutes set

forth the minimum requirements for state Medicaid programs to qualify for federal funding. 42

U.S.C. § 1396a.

10. The DSS Commissioner is authorized to promulgate regulations necessary to

administer the CMAP, including the State of Connecticut's Medicaid program. Regulations of

Connecticut State Agencies (R.C.S.A.) § 17b-262-523(13).

CMAP PROVIDER ENROLLMENT AND PARTICIPATION

11. The CMAP requires all providers who wish to participate in the CMAP to enroll

and enter into an agreement with the DSS, known as a provider agreement. This agreement,

which is periodically updated, remains in effect for the duration specified in the agreement. The

provider agreement specifies conditions and terms that govern the program which the provider is

mandated to adhere to in order to participate in the program. R.C.S.A. § 17b-262-524.

12. During the relevant time period Defendant Britt was enrolled in the CMAP as a

provider, and was a party to a provider agreement with the DSS (Provider Agreement).

Defendant Britt executed the Provider Agreement on January 12, 2012.

13. Defendant Britt was enrolled in the CMAP as a behavioral health clinician, and

more particularly, as a professional counselor. See R.C.S.A. § 17b-262-913(15) (defining

licensed professional counselor as one type of licensed behavioral health clinician).

CMAP PAYMENT REQUIREMENTS

14. The Provider Agreement between Defendant Britt and the DSS obligates Britt to

submit to the DSS only those claims seeking reimbursement for covered goods and services that

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are medically necessary and actually provided to the Medicaid beneficiaries in whose name the

claims are made. Provider Agreement, Para. 15.

15. To receive payment for covered goods and services provided to CMAP

beneficiaries, providers are required, among other things, to meet and maintain all DSS

enrollment requirements. R.C.S.A. §§ 17b-262-914 and 17b-262-524.

16. The Provider Agreement requires Defendant Britt to comply with all laws,

regulations, and DSS enrollment requirements. The Provider Agreement and state regulations

expressly condition payment to the provider upon such compliance. R.C.S.A. §§ 17b-262-522,

17b-262- 524, 17b-262-526, and R.C.S.A. §§ 17b-262-914-16; Provider Agreement, Paras. 1

and 2.

17. State regulations and the Provider Agreement require that any overpayment for

CMAP goods or services, defined as the excess over the payment authorized, or any payment

owed to the DSS because of a violation due to abuse or fraud, shall be payable to the DSS.

R.C.S.A. § 17b-262-533; R.C.S.A. § 17b-262-523(18); Provider Agreement, Para. 23.

18. The DSS may recover any overpayments which the provider does not repay by

bringing an action against the provider. Provider Agreement, Para. 23.

REQUIREMENTS FOR THE DOCUMENTATION OF SERVICES

19. State regulations and the Provider Agreement require licensed professional

counselors to maintain specific documentation of the services they provide to their clients.

20. Specifically, state regulations require licensed professional counselors to

maintain, without limitation, "pertinent diagnostic information, a current treatment plan signed

by the licensed [professional counselor], ... documentation of services provided, including types

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of service or modalities, date of service, location of the service and the start and stop time of the

service." R.C.S.A. § 17b-262-925(a).

21. Licensed professional counselors must maintain their records for a minimum of

five years. R.C.S.A. § 17b-262-925(c).

22. The DSS "may disallow and recover any amounts paid to the provider for which

required documentation is not maintained and provided to the [DSS] upon request." R.C.S.A. §

17b-262-925(d.

23. The Provider Agreement also requires Defendant Britt to maintain specific patient

records for each patient, including without limitation "pertinent diagnostic information including

x-rays; current treatment plan; treatment notes; documentation of dates of services and services

provided; and all other information required by state and federal law." Provider Agreement, Para.

7.

24. In addition, the Provider Agreement requires Defendant Britt to "maintain fiscal,

medical, and programmatic records which fully disclose services and goods rendered and/or

delivered to eligible clients," and to make her records and information "available to authorized

[government] representatives upon request ... including but not limited to, information regarding

payments claimed by the Provider for furnishing goods and services." Provider Agreement, Para.

21.

25. The Provider Agreement obligates Defendant Britt to "cooperate fully and make

available to state and federal officials and their agents all records and information that such

officials have determined to be necessary to assure the appropriateness of the payments the DSS

made to Britt, and "to assure Provider's compliance with all applicable statutes and regulations

and policies." Provider Agreement, Para. 22.

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26. In the event a provider dies or retires, state regulations require all healthcare

providers and/or their successors to notify their patients by letter and publication in a newspaper,

and to retain the "[m]edical records of all patients ... for at least sixty days following both the

public and private notice to patients." R.C.S.A. § 19a-14-44.

THE FALSE CLAIMS SCHEME - A PERVASIVE PATTERN OF FRAUDULENT BILLING

27. During the relevant time period Defendant Britt conducted her counseling practice

at her personal residence in Norwich, Connecticut.

28. Defendant Britt submitted claims to the CMAP for the counseling services she

purportedly performed for her Medicaid clients.

29. Defendant Britt regularly received payments from the CMAP by check or

electronic funds transfer as reimbursement for the claims she submitted for the counseling

services she purportedly provided to her Medicaid clients.

30. During the relevant time period the DSS reimbursed Defendant Britt a total of

more than $530,000 for the claims she submitted for the services she purportedly provided to her

Medicaid patients.

31. From at least as early as January 2013 through September 2016, Defendant Britt

systematically and knowingly submitted false and fraudulent claims to the DSS for counseling

services that Defendant Britt purported to have performed at her home office in Norwich,

Connecticut, but which in fact she never provided to CMAP beneficiaries.

32. Defendant Britt falsified claims in several ways. In many instances, Defendant

Britt provided bona fide counseling services to patients once or twice a week, but she submitted

phony claims and received payment for three or four additional weekly counseling sessions with

these patients that she in fact never conducted. .

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33. In other instances, Defendant Britt provided some bona fide counseling services

to children, and met separately with their parents on one or two occasions. Using the parents'

Medicaid identification number, Defendant Britt then submitted falsified claims for numerous

dates of service for counseling sessions she never provided to the parents.

34. Defendant Britt submitted these phony claims to the CMAP using the billing code

that reimbursed her at the highest rate paid by the CMAP for counseling services.

35. Defendant Britt submitted such claims for behavioral health services she

purported to have rendered to Medicaid patients, and received payment for them from the

CMAP, even though Defendant Britt rendered no services and did not treat these patients on the

dates of services delineated on the claim forms.

36. More specifically, the following are examples of Medicaid patients for whom

Defendant Britt submitted and received payment for numerous false claims:

A. During the period from March 6, 2015, through September 1, 2016, Defendant

Britt billed the CMAP and received payment for behavioral health services she purported to have

provided to Patient 1. Defendant Britt submitted 139 claims to the CMAP for these services, but

for at least 95 of these claims she did not provide any service to Patient 1. Defendant Britt

received $8,989 for these 95 false claims for services that she never provided.

B. During the period from February 27, 2016, through September 1,2016, Defendant





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C. During the period from February 27, 2016, through September 1, 2016, Defendant





37. For some of the dates of service Defendant Britt billed the CMAP for services she

purportedly provided to Medicaid patients in Connecticut, the patients in fact were traveling out

of state.

INTENTIONAL DESTRUCTION OF RECORDS

38. On or about March 3, 2017, the Connecticut Attorney General, pursuant to the

Act, issued and caused to be served on Defendant Britt a subpoena dated February 28, 2017

(Subpoena). The Subpoena directed Defendant Britt to produce all documents concerning the

dates, times and lengths of patient appointments, claims for reimbursement, patient diagnoses,

and treatment plans and recommendations.

39. Britt did not produce any of these documents. Instead, when she was served with

the Subpoena, Defendant Britt informed government investigators that in late May or early June

2016 she destroyed all of her records for all of her patients, including the records documenting

her patients' appointments and the services she purportedly provided to these patients.

40. In response to the Subpoena, Defendant Britt submitted a sworn statement to

representatives of the Office of the Attorney General stating that she had made a diligent search

of all locations where responsive documents might be located, and that the documents she had

produced - which did not concern patient records - constituted all of the responsive documents

within her custody, control or possession.

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41. In addition, Defendant Britt represented in a writing she provided to

representatives of the Office of the Attorney General dated March 16, 2017, that she had no

records pertaining to her Medicaid patients, and that she had destroyed all of her patient files;

purportedly to protect her patients' health information in the event of her death.

42. Defendant Britt continued to submit claims to the CMAP and receive payment for

services she purportedly provided to her patients during June, July, and August 2016, long after

the date she purportedly had destroyed her records.

43. Defendant Britt never gave notice to her patients, as required by R.C.S.A. § 19a-

14-44, before she purportedly destroyed their records.

COUNT ONE -Presentation of False Claims - Conn. Gen. Stat § 4-275(a)(l)

. 44. The allegations of paragraphs 1 — 43 of this complaint are incorporated herein as

allegations of Count One as if fully set forth herein.

45. Pursuant to the Act, Connecticut General Statutes § 4-275(a)(l), no person shall'

knowingly present, or cause to be presented, a false or fraudulent claim for payment or approval

under a healthcare services program administered by the DSS.

46. From January 2013 through September 2016, Defendant Britt knowingly engaged

in a long-term pattern and practice of submitting false claims to the DSS for services that

Defendant Britt purportedly performed but in fact never rendered.

47. From January 2013 through September 2016, Defendant Britt knowingly

presented or caused to be presented, to an officer or employee of the state, false or fraudulent

claims for payment or approval under a healthcare services program administered by the DSS.

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48. By virtue of the false or fraudulent claims made or caused to be made by

Defendant Britt, the State has suffered damages.

49. Defendant Britt is liable to the state for treble damages under the Act, in an

amount to be determined at trial, plus a civil penalty of $5,500 to $11,000 for each false claim

presented or caused to be presented by the Defendant.

COUNT TWO -Concealing An Obligation to Pay Back An Overpayment - Conn.

Gen. Stat. § 4-275(a)ffl

50. The allegations of paragraphs 1 — 49 of this complaint are incorporated herein as

allegations of Count Two as if fully set forth herein.

51. Pursuant to the Act, Connecticut General Statutes § 4-274(5), "[ojbligation means

an established duty, whether fixed or not, arising from...(C) statute or regulation, or (D) the

retention of an overpayment."

52. Pursuant to the Act, Connecticut General Statutes § 4-275(a)(8), no person shall

knowingly conceal or knowingly and improperly avoid or decrease an obligation to pay money

to the state under a healthcare services program administered by the DSS.

53. By failing to maintain or destroying all of her patient records of any actual

services she may have provided, Defendant Britt effectively concealed evidence of her scheme to

submit false claims to the DSS for services she never provided.

54. By failing to maintain or destroying her patient records, Defendant Britt

knowingly concealed or knowingly and improperly avoided or decreased her obligation to repay

the state the overpayments she received under a medical assistance program administered by the

DSS for the services she billed the CMAP for but never provided to her clients.

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55. The State has suffered damages due to Defendant Britt's knowing concealment or

knowing and improper avoidance or decrease of her obligation to repay the state the

overpayments she received under a medical assistance program administered by DSS,

COUNT THREE - Breach of Contract

56. The allegations of paragraphs 1 — 55 of this complaint are incorporated herein as

allegations of Count Three as if fully set forth herein.

57. The Provider Agreement establishes duties for Defendant Britt: (a) to maintain

records pertaining to the services she provided to her patients, including without limitation

diagnostic information, treatment plans and notes, the types of services provided, and the dates

and times she provided these services, and (b) to provide her records to the DSS in order to

verify that she provided the services for which she received payment from the DSS. Provider

Agreement, Paras. 7, 21, and 22.

58. The Provider Agreement also establishes a duty for Defendant Britt to comply

with all federal and state regulations pertaining to her participation in the CMAP, including those

requiring Britt to maintain patient records regarding the services actually provided to patients,

and the dates and times of those services. R.C.S.A. § 17b-262-925(a) and (c).

59. Pursuant to state regulations and the Provider Agreement, the DSS's payments to

Defendant Britt were conditioned on Britt adequately documenting the services she purported to

provide to her patients. R.C.S.A. §§ 17b-262-522, 524, and 526; R.C.S.A. §§ 17b-262-914-16.

60. Pursuant to state regulations and the Provider Agreement, the DSS may disallow

and recover any amounts paid to the provider for which required documentation is not

maintained and provided to the DSS upon request. R.C.S.A. § 17b-262-925(d).

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61. From 2013 through 2016 Defendant Britt received payments of at least $530,000

from the DSS as reimbursement for the claims she submitted to the CMAP for the licensed

professional counseling services she purportedly provided to her Medicaid patients.

62. Defendant Britt never maintained or destroyed all of her records regarding the

services she purported to have delivered to her patients, and failed to provide any documentation

of any services to the DSS's agents when they demanded her records.

63. The DSS has complied with all of its material obligations required of it under the

terms and conditions of the Provider Agreement.

64. Defendant Britt breached her duties under the Provider Agreement to maintain

records documenting the services she claimed to have provided to her patients, for which the

DSS paid her $530,000, and to provide these records to the DSS.

65. The DSS is entitled to recover all amounts which it paid to Defendant Britt

because she failed to maintain the required documentation, and failed to provide any

documentation to the DSS when the DSS requested it.

66. The State has suffered damages as a result of Defendant Britt's breach of the

Provider Agreement.

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DEMAND FOR RELIEF

WHEREFORE, the STATE OF CONNECTICUT requests the following relief:

1. Pursuant to Conn. Gen. Stat. § 4-275(b), a civil penalty of not less than five

thousand five hundred dollars or more than eleven thousand dollars, or as adjusted from

time to time by the Federal Civil Penalties Inflation Adjustment Act of 1990, 28 U.S.C.

§ 2461, for each violation of the Act;

2. Pursuant to Conn. Gen. Stat. § 4-275(b), three times the amount of damages that

the State of Connecticut sustained because of the acts of Defendant Britt.

3. Pursuant to Conn. Gen. Stat. § 4-275(b), costs of investigation and prosecution of

this action;

4. Money damages; and

5. Such other relief as is just and equitable to effectuate the purposes of this action.

The amount, legal interest or property in demand is $15,000 or more, exclusive of interest

or costs.

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Dated at Hartford, Connecticut, this [Tjilay of June, 2018.

PLAINTIFF STATE OF CONNECTICUT

BY: GEORGE JEPSEN ATTORNEY GENERAL

1M M Michel E. Cole (Juris #417145) Assistant Attorney General Chief, Government Program Fraud Department 55 Elm Street, P.O. Box 120 Hartford, CT 06141-0120 Tel: (860) 808-5040/Fax: (860) 808-5033 Emaijb Michael.cole@ct. gov

Richard M. Porter (Juris #423015) Assistant Attorney General 55 Elm Street, P.O. Box 120 Hartford, CT 06141-0120 Tel: (860) 808-5040/Fax: (860) 808-5391 Email: [email protected]

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